Meta-analysis shows colon capsule endoscopy is effective in detecting colorectal polyps

Abstract

Background & aims: Colon capsule endoscopy (CCE) is a noninvasive and painless technique used to explore the colon without sedation or air insufflation. We performed a systematic review and meta-analysis to assess the accuracy of CCE in detecting colorectal polyps.

Methods: The MEDLINE, EMBASE, and SCOPUS databases were searched, from 2006 to 2009, for the terms "colon capsule" and "Pillcam colon"; searches included abstracts. Studies were included that focused on detecting colorectal polyps with CCE and that were verified using within-subject reference colonoscopy. The risk of bias within each study was ascertained according to Quality Assessment of Diagnostic Accuracy in Systematic Reviews recommendations. The per-patient sensitivity and specificity were calculated for polyps of any size and for significant findings (polyps, > or =6 mm in size or >3 in number). Forest plots were produced based on random-effect models. The risk of bias across studies was assessed using the interstudy heterogeneity statistic, meta-regression, and the Egger test.

Results: Eight studies provided data on 837 patients; the prevalences of polyps and significant findings were 57% and 27.4%, respectively. CCE sensitivity for polyps of any size and significant findings were 71% and 68%, respectively. CCE specificity for polyps of any size and significant findings were 75% and 82%, respectively. High levels of heterogeneity (interstudy heterogeneity, >75%) were not detected. Moderate heterogeneity partially was explained by the different design of individual studies. CCE identified 16 of the 21 cancerous lesions detected by colonoscopy (pooled sensitivity, 76%).

Conclusions: CCE sensitivity for polyps and significant findings compares favorably with other noninvasive colorectal cancer screening strategies. CCE specificity is likely to be underestimated because reference colonoscopy examination results are blinded.